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d'Errico A, Fontana D, Sacerdote C, Ardito C. Child rearing or childbearing? Risk of cardiovascular diseases associated to parity and number of children. BMC Public Health 2024; 24:272. [PMID: 38263016 PMCID: PMC10804732 DOI: 10.1186/s12889-023-17119-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. METHODS The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. RESULTS CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02-1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10-1.83; and HR = 1.39, 95% CI: 1.03-1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. CONCLUSIONS Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.
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Affiliation(s)
- Angelo d'Errico
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Dario Fontana
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, University of Turin, Turin, Italy
- Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - Chiara Ardito
- Competence Centre On Microeconomic Evaluation (CC-ME), European Commission, Joint Research Centre (JRC), Ispra, Italy.
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2
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Xie F, Agrawal S, Johnson EF, Wieland CN, Davis DMR, Theiler RN, Lehman JS. Updates on the dermatopathology of pregnancy-associated skin conditions. Hum Pathol 2023; 140:173-195. [PMID: 37209919 DOI: 10.1016/j.humpath.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Shruti Agrawal
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dawn Marie R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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3
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Bossung V, Singer A, Ratz T, Rothenbühler M, Leeners B, Kimmich N. Changes in Heart Rate, Heart Rate Variability, Breathing Rate, and Skin Temperature throughout Pregnancy and the Impact of Emotions-A Longitudinal Evaluation Using a Sensor Bracelet. SENSORS (BASEL, SWITZERLAND) 2023; 23:6620. [PMID: 37514915 PMCID: PMC10385491 DOI: 10.3390/s23146620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
(1) Background: Basic vital signs change during normal pregnancy as they reflect the adaptation of maternal physiology. Electronic wearables like fitness bracelets have the potential to provide vital signs continuously in the home environment of pregnant women. (2) Methods: We performed a prospective observational study from November 2019 to November 2020 including healthy pregnant women, who recorded their wrist skin temperature, heart rate, heart rate variability, and breathing rate using an electronic wearable. In addition, eight emotions were assessed weekly using five-point Likert scales. Descriptive statistics and a multivariate model were applied to correlate the physiological parameters with maternal emotions. (3) Results: We analyzed data from 23 women using the electronic wearable during pregnancy. We calculated standard curves for each physiological parameter, which partially differed from the literature. We showed a significant association of several emotions like feeling stressed, tired, or happy with the course of physiological parameters. (4) Conclusions: Our data indicate that electronic wearables are helpful for closely observing vital signs in pregnancy and to establish modern curves for the physiological course of these parameters. In addition to physiological adaptation mechanisms and pregnancy disorders, emotions have the potential to influence the course of physiological parameters in pregnancy.
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Affiliation(s)
- Verena Bossung
- Department of Obstetrics, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Adrian Singer
- Department of Obstetrics, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Tiara Ratz
- Department of Reproductive Endocrinology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | | | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Nina Kimmich
- Department of Obstetrics, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
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Alkhatib B, Salimi S, Jabari M, Padmanabhan V, Vyas AK. Impact of Adverse Gestational Milieu on Maternal Cardiovascular Health. Endocrinology 2023; 164:bqad060. [PMID: 37042476 PMCID: PMC10164662 DOI: 10.1210/endocr/bqad060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/13/2023]
Abstract
Cardiovascular disease affects 1% to 4% of the nearly 4 million pregnancies in the United States each year and is the primary cause of pregnancy-related mortality. Adverse pregnancy outcomes are associated with cardiovascular complications during pregnancy persisting into the postpartum period. Recently, investigations have identified an altered sex hormone milieu, such as in the case of hyperandrogenism, as a causative factor in the development of gestational cardiovascular dysfunction. The mechanisms involved in the development of cardiovascular disease in postpartum women are largely unknown. Animal studies have attempted to recapitulate adverse pregnancy outcomes to investigate causal relationships and molecular underpinnings of adverse gestational cardiac events and progression to the development of cardiovascular disease postpartum. This review will focus on summarizing clinical and animal studies detailing the impact of adverse pregnancy outcomes, including preeclampsia, gestational diabetes mellitus, and maternal obesity, on gestational cardiometabolic dysfunction and postpartum cardiovascular disease. Specifically, we will highlight the adverse impact of gestational hyperandrogenism and its potential to serve as a biomarker for maternal gestational and postpartum cardiovascular dysfunctions.
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Affiliation(s)
- Bashar Alkhatib
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA
| | - Shadi Salimi
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | - Mary Jabari
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | | | - Arpita Kalla Vyas
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
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Fogel-Yaakobi S, Golland Y, Levit-Binnun N, Borelli JL, Mikulincer M, Shai D. The moderating role of attachment in the association between physiological synchrony in married couples and supportive behavior in the transition to parenthood. Psychophysiology 2023:e14263. [PMID: 36828778 DOI: 10.1111/psyp.14263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 02/26/2023]
Abstract
Despite supportive behaviors playing a central role in intimate relationships, the extent to which physiological and psychological factors are involved in the quality of the observed spousal support, remains largely unknown. From a physiological stance, cardiac synchrony has been identified as an important component involved in dyadic interpersonal interactions. This study aims to examine whether individual differences in attachment determine, at least to some extent, whether cardiac synchrony enhances or impedes the quality of the observed spousal support. Specifically, this study examines whether attachment style moderates the biobehavioral link between positive cardiac synchrony and observed spousal support. A total of 58 couples expecting their first child participated in a supportive interaction while their cardiovascular responses were recorded, and the quality of their caregiving behaviors was coded. Results indicated that couples' cardiovascular dynamics were synchronized during the supportive interaction. Furthermore, attachment moderated the association between positive cardiac synchrony and the behavioral manifestation of support, such that cardiac synchrony was negatively associated with the quality of support when offered by caregivers with higher scores of attachment anxiety. Our findings show that for those caregivers who have higher levels of anxious attachment-being synchronized with their care seeking spouses is associated with difficulties in providing effective support. We discuss these findings in the context of the emotion regulation difficulties characteristic of anxious attachment patterns. These findings suggest that future work could benefit from performing comprehensive studies that consider physiological, behavioral, and psychological constructs simultaneously.
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Affiliation(s)
| | - Yulia Golland
- Ivcher School of Psychology, Reichman University (Interdisciplinary Center Herzliya), Herzliya, Israel
| | - Nava Levit-Binnun
- Ivcher School of Psychology, Reichman University (Interdisciplinary Center Herzliya), Herzliya, Israel
| | - Jessica L Borelli
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, California, USA
| | - Mario Mikulincer
- Ivcher School of Psychology, Reichman University (Interdisciplinary Center Herzliya), Herzliya, Israel
| | - Dana Shai
- SEED Center, School of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
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Murphy VE, Jensen ME. Longitudinal Changes in Upper and Lower Airway Function in Pregnancy. Immunol Allergy Clin North Am 2023; 43:17-26. [PMID: 36411003 DOI: 10.1016/j.iac.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Physiologic changes during pregnancy have implications for both upper and lower airway function. Upper airway resistance increases, and total lung capacity decreases. Upper airway symptoms increase; some women develop pregnancy-induced rhinitis and there is an increased prevalence of sleep-disordered breathing compared to prepregnancy. Longitudinal studies examining changes in upper and lower airway function parameters are limited, particularly in women with asthma. Some studies have observed reduced lung function with advancing gestation; however, changes are small and unlikely to be of major clinical significance. Spirometry is therefore a useful tool for clinical assessment of women with asthma during pregnancy.
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Affiliation(s)
- Vanessa E Murphy
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Level 2 West, c/- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Megan E Jensen
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Level 2 West, c/- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
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Thompson SE, Prabhakar CRK, Creasey T, Stoll VM, Gurney L, Green J, Fox C, Morris RK, Thompson PJ, Thorne SA, Clift P, Hudsmith LE. Pregnancy outcomes in women following the Ross procedure. Int J Cardiol 2023; 371:135-139. [PMID: 36181953 DOI: 10.1016/j.ijcard.2022.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Ross procedure, where a pulmonary autograft (neoaorta) replaces the aortic valve, has excellent long-term outcomes in patients with congenital aortic valve disease. However, there are reports of neoaortic dilatation and dissection. An increasing number of women are wishing to become pregnant following the Ross procedure, but little is known about the occurrence and risks of neoaortic dilatation and complications in pregnancy. We investigated neoaorta function and outcomes in pregnancy following the Ross procedure. METHODS This retrospective study investigated women post-Ross procedure at a tertiary ACHD unit between 1997 and 2021. Imaging evaluated neoaortic root dimensions and regurgitation pre-, and post- pregnancy, compared with matched non-pregnant controls. Primary endpoints were change in neoaortic dimensions, degree of regurgitation and adverse maternal outcomes. RESULTS Nineteen pregnancies in 12 women were included. The mean change in neoaortic root diameter post-pregnancy was 1.8 mm (SD 3.4) (p = 0.017). There was no significant change in neoaortic dimensions in matched controls during follow-up. There were no cases of dissection, arrhythmia, acute coronary syndrome, or maternal mortality. Three deliveries were pre-term, including one emergency Caesarean section due to maternal cardiac decompensation, requiring aortic root replacement post-partum but there were no neonatal deaths. CONCLUSIONS Pregnancy following the Ross procedure is associated with neoaortic dilatation, and pregnancy is generally well tolerated. Although adverse maternal outcomes are uncommon, there are still rare cases of cardiac complications in and around the time of pregnancy. These findings emphasise the need for accessible pre-pregnancy counselling, risk stratification and careful surveillance through pregnancy by specialist cardio-obstetric multi-disciplinary teams.
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Affiliation(s)
- Sophie E Thompson
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospital, Birmingham, UK.
| | | | - Tristan Creasey
- Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Victoria M Stoll
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospital, Birmingham, UK; Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Leo Gurney
- Department of Maternal and Fetal Medicine, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Jennifer Green
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospital, Birmingham, UK
| | - Caroline Fox
- Department of Maternal and Fetal Medicine, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - R Katie Morris
- Department of Maternal and Fetal Medicine, Birmingham Women's and Children's Hospital, Birmingham, UK; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peter J Thompson
- Department of Maternal and Fetal Medicine, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Sara A Thorne
- Division of Cardiology, Pregnancy & Heart Disease Program, Mount Sinai Hospital & University Health Network, University of Toronto, Canada
| | - Paul Clift
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospital, Birmingham, UK
| | - Lucy E Hudsmith
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospital, Birmingham, UK
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Maternal risk factors associated with term low birth weight in India: A review. ANTHROPOLOGICAL REVIEW 2023. [DOI: 10.18778/1898-6773.85.4.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Low birth weight is one of the leading factors for infant morbidity and mortality. To a large extent affect, various maternal risk factors are associated with pregnancy outcomes by increasing odds of delivering an infant with low birth weight. Despite this association, understanding the maternal risk factors affecting term low birth weight has been a challenging task. To date, limited studies have been conducted in India that exert independent magnitude of these effects on term low birth weight. The aim of this review is to examine the current knowledge of maternal risk factors that contribute to term low birth weight in the Indian population. In order to identify the potentially relevant articles, an extensive literature search was conducted using PubMed, Goggle Scholar and IndMed databases (1993 – Dec 2020). Our results indicate that maternal age, educational status, socio-economic status, ethnicity, parity, pre-pregnancy weight, maternal stature, maternal body mass index, obstetric history, maternal anaemia, gestational weight gain, short pregnancy outcome, hypertension during pregnancy, infection, antepartum haemorrhage, tobacco consumption, maternal occupation, maternal psychological stress, alcohol consumption, antenatal care and mid-upper arm circumference have all independent effects on term low birth weight in the Indian population. Further, we argue that exploration for various other dimensions of maternal factors and underlying pathways can be useful for a better understanding of how it exerts independent association on term low birth weight in the Indian sub-continent.
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Enkhmaa D, Ganmaa D, Tanz LJ, Rich-Edwards JW, Stuart JJ, Enkhtur S, Gantsetseg G, Batkhishig B, Fitzmaurice G, Bayalag M, Nasantogtokh E, Bairey Merz CN, Shufelt CL. Changes in Vascular Function from Preconception to Postpartum Among Mongolian Women. J Womens Health (Larchmt) 2022; 31:1655-1663. [PMID: 35904927 PMCID: PMC9700357 DOI: 10.1089/jwh.2021.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pregnancy is associated with physiological changes to meet the metabolic demands of the growing fetus. To understand adverse pregnancy outcomes it is important to establish vascular changes throughout pregnancy. We examined longitudinal changes in vascular measurements from prepregnancy through postpartum. Materials and Methods: Seventy women planning to conceive in Ulaanbaatar, Mongolia enrolled in this prospective study. Within 6 months, 44 (63%) had conceived; of which 36 (82%) delivered. Ten (28%) developed complex pregnancies and were analyzed separately. Vascular measures included central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), augmentation index corrected for heart rate of 75 beats/minute (AIx-75), and pulse wave velocity (PWV). Measurements were performed at prepregnancy, second trimester (22-24 weeks), third trimester (34-36 weeks), and 2 months postpartum. Missing values (n = 0-6 per time period) were replaced by multiple imputation. A repeated measures analysis of variance analyzed changes within individual women over the four time points adjusted for age, parity, and body mass index. Results: We observed significant reductions from prepregnancy to second trimester for mean Alx-75 (17.1%-12.6%; p = 0.006) and cSBP (91.7-86.8 mmHg; p = 0.03) but not for cDBP or PWV. Both mean AIx-75 and cSBP increased in third trimester. In the postpartum, cSBP returned to prepregnancy levels, whereas AIx-75 exceeded prepregnancy levels, although this fell short of significance (p = 0.09). Similar vascular patterns were observed in women with complex pregnancies for AIx-75; however, PWV increased from the second trimester and remained higher through postpartum, although not significant. Conclusion: In Mongolian women, we observed a decrease in AIx-75 and cSBP from prepregnancy through second trimester, which resolved postpartum. These results provide an understanding of changes across pregnancies in an Asian country. Future studies should assess vascular changes across pregnancies to determine if it can predict conditions such as pre-eclampsia.
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Affiliation(s)
- Davaasambuu Enkhmaa
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Davaasambuu Ganmaa
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lauren J. Tanz
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Janet W. Rich-Edwards
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer J. Stuart
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shonkhuuz Enkhtur
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Garmaa Gantsetseg
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Bandi Batkhishig
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Garrett Fitzmaurice
- McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Munkhuu Bayalag
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - Erdenebileg Nasantogtokh
- National Center for Maternal and Child Health, Department of Maternal Health Research, Ulaanbaatar, Mongolia
| | - C. Noel Bairey Merz
- Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Chrisandra L. Shufelt
- Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Smidt Heart Institute, Los Angeles, California, USA
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Hemostasis System and Plasminogen Activity in Retrochorial Hematoma in the First Trimester of Pregnancy. Biomedicines 2022; 10:biomedicines10092284. [PMID: 36140384 PMCID: PMC9496394 DOI: 10.3390/biomedicines10092284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: The components of the fibrinolytic system and its main component, plasminogen, play a key role in the first months of pregnancy. The effect of autoantibodies interacting with plasminogen in the formation of retrochorial hematoma is unknown. The aim of our study was to determine the role of plasminogen and IgA, IgM, and IgG, which bind to plasminogen, in retrochorial hematoma. (2) Methods: Prothrombin time (PT), thrombin time (TT), partial activated thromboplastin time (aPTT), soluble fibrin-monomer complex (SFMC), D-dimer, plasminogen activity (%Plg), plasminogen concentration (Plg), and the levels of IgG (IgG-Plg), IgM (IgM-Plg), IgA (IgA-Plg) interacting with plasminogen were determined in plasma samples of 57 women with normal pregnancy and 16 with retrochorial hematoma. (3) Results: %Plg in plasma samples from women with retrochorial hematoma was significantly lower than in plasma samples from women with normal pregnancy. The diagnostic significance of %Plg in the ROC analysis was AUC = 0.85. A direct correlation was found between aPTT and the level of autologous IgM interacting with plasminogen. (4) Conclusions: A decrease in the activity of plasminogen in the blood serum of women in the first trimester of pregnancy may indicate disturbances in the hemostasis system and the formation of retrochorial hematoma. According to the results of the study, it is possible to recommend the determination of plasminogen activity in the management of pregnant women in gynecological practice.
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Gédéon T, Akl E, D'Souza R, Altit G, Rowe H, Flannery A, Siriki P, Bhatia K, Thorne S, Malhamé I. Acute Myocardial Infarction in Pregnancy. Curr Probl Cardiol 2022; 47:101327. [PMID: 35901856 DOI: 10.1016/j.cpcardiol.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular disease, and particularly ischemic heart disease, is a leading cause of maternal morbidity and mortality in high-income countries. The incidence of acute myocardial infarction (AMI) has been rising over the past two decades due to increasing maternal age and a higher prevalence of cardiovascular risk factors in the pregnant population. Causes of AMI in pregnancy are diverse and may require specific considerations for their diagnosis and management. In this narrative review, we provide an overview of physiologic changes, risk factors, and etiologies leading to AMI in pregnancy, as well as diagnostic tools, reperfusion strategies, and pharmacological treatments for this complex population. In addition, we outline considerations for labor and delivery planning and long-term follow-up of patients with AMI in pregnancy.
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Affiliation(s)
- Tara Gédéon
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Elie Akl
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Gabriel Altit
- Department of Paediatrics, McGill University Health Centre, Montreal, Canada
| | - Hilary Rowe
- Department of Pharmacy, Nanaimo Regional General Hospital, Island Health, Nanaimo, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Alexandria Flannery
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Kailash Bhatia
- Department of Anaesthesia, Manchester University Hospitals and St Mary's Hospital, University of Manchester, Manchester, United Kingdom
| | - Sara Thorne
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
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Di Filippo S, Godoy DA, Manca M, Paolessi C, Bilotta F, Meseguer A, Severgnini P, Pelosi P, Badenes R, Robba C. Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint. Front Neurol 2022; 13:911460. [PMID: 35756939 PMCID: PMC9218270 DOI: 10.3389/fneur.2022.911460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Moderate and severe traumatic brain injury (TBI) are major causes of disability and death. In addition, when TBI occurs during pregnancy, it can lead to miscarriage, premature birth, and maternal/fetal death, engendering clinical and ethical issues. Several recommendations have been proposed for the management of TBI patients; however, none of these have been specifically applied to pregnant women, which often have been excluded from major trials. Therefore, at present, evidence on TBI management in pregnant women is limited and mostly based on clinical experience. The aim of this manuscript is to provide the clinicians with practical suggestions, based on 10 rules, for the management of moderate to severe TBI during pregnancy. In particular, we firstly describe the pathophysiological changes occurring during pregnancy; then we explore the main strategies for the diagnosis of TBI taking in consideration the risks related to mother and fetus, and finally we discuss the most appropriate approaches for the management in this particular condition. Based on the available evidence, we suggest a stepwise approach consisting of different tiers of treatment and we describe the specific risks according to the severity of the neurological and systemic conditions of both fetus and mother in relation to each trimester of pregnancy. The innovative feature of this approach is the fact that it focuses on the vulnerability and specificity of this population, without forgetting the current knowledge on adult non-pregnant patients, which has to be applied to improve the quality of the care process.
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Affiliation(s)
- Simone Di Filippo
- Department of Biotechnology and Sciences of Life, Anesthesia and Intensive Care, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Daniel Agustin Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina
- Intensive Care, Hospital Carlos Malbran, Catamarca, Argentina
| | - Marina Manca
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Camilla Paolessi
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Federico Bilotta
- Department of Anesthesiology, University of Rome “Sapienza”, Rome, Italy
| | - Ainhoa Meseguer
- Department of Obstetrics, Hospital Francesc de Borja, Gandia, Spain
| | - Paolo Severgnini
- Department of Biotechnology and Sciences of Life, Anesthesia and Intensive Care, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Universitat de València, Valencia, Spain
| | - Chiara Robba
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
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Eitenmüller P, Köhler S, Hirsch O, Christiansen H. The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis. Front Psychiatry 2022; 13:815822. [PMID: 35706472 PMCID: PMC9189288 DOI: 10.3389/fpsyt.2022.815822] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Negative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems. METHOD Three hundred and fifty-four women (18-43 years; M = 30.13, SD = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status. RESULTS Primipara reported significantly more birth complications (p = 0.048), with path analysis confirming this result (p < 0.001). Birth complications were associated with a more negative rating of the overall birth experience (p < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores (p < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment (p > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding (p < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression. DISCUSSION The present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.
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Affiliation(s)
- Pia Eitenmüller
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Siegmund Köhler
- Department of Obstetrics and Gynecology, University of Giessen-Marburg, Marburg, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
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Babik B, Kupcsulik S, Fazakas J. Gestational hemostasis: a natural model for hemostasis resuscitation of major periprocedural blood loss : "Look deep into nature, and then you will understand everything better." Albert Einstein. Perioper Med (Lond) 2021; 10:54. [PMID: 34895336 PMCID: PMC8667437 DOI: 10.1186/s13741-021-00225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/03/2021] [Indexed: 11/10/2022] Open
Abstract
Early goal-directed treatment is an evidence-based approach to guide hemostatic therapy during major periprocedural bleeding. If viscoelastic coagulation tests are not available, an algorithm, termed the pyramid of hemostatic interventions, can help manage severe bleeding. Pregnant women accumulate huge reserves of prothrombotic and antifibrinolytic hemostatic elements to avoid peripartum blood loss. We provide comparison of therapeutic hemostatic approaches and natural gestational process and identified remarkable analogy between early goal-directed management of bleeding and hemostatic adaptation of pregnant woman. Therefore, gestational hemostasis serves as a natural model for goal-directed hemostasis resuscitation and can foster understanding of hemostatic management of periprocedural bleeding.
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Affiliation(s)
- Barna Babik
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.
| | - Szilvia Kupcsulik
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - János Fazakas
- Clinic of Transplantation and Surgery, Semmelweis University, Baross Str. 23, Budapest, Hungary
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Lobo L, Esteves-Guimarães J, Oliveira P, Salazar L, Pereira A, Fontes-Sousa AP. Maternal Left Ventricular Diastolic and Systolic Function during Normal Pregnancy in Saint Bernard Dogs. Vet Sci 2021; 8:vetsci8120306. [PMID: 34941833 PMCID: PMC8705166 DOI: 10.3390/vetsci8120306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to evaluate maternal left ventricular (LV) systo-diastolic function using conventional and TDI echocardiography and included 10 healthy Saint-Bernard pregnant bitches. M-mode, peak transmitral flow velocities during early diastole (E) and atrial contraction (A), aortic and pulmonic flow, myocardial performance index (MPI), TDI studies (peak myocardial velocities during early diastole (E’), atrial contraction (A’) and peak systole (S’)), and blood pressure were measured at 21 to 28 (T1), 40 (T2) and 60 (T3) days of gestation and four to eight weeks postpartum (T4). Cardiac output and heart rate were 20% and 9% higher at T3, respectively, compared to T4 (p < 0.01). Lateral S’ was 36% higher at T3 than at T1 (p < 0.05). Changes in diastolic function were demonstrated by 10% lower E wave and 15% A wave at T1, compared to T4 (p < 0.05). E’ and A’ were 23% and 42% higher at T3 compared to T4 (p < 0.01). Both lateral E/E’ and E’/A’ were 6% and 19% lower at T3 compared to T1 (p < 0.01 and p < 0.05, respectively). At T3, MPI was 51% and 34% lower when compared to T1 or T2 (p < 0.05). The echocardiographic evaluation of maternal cardiac function is important, as structural, and functional changes occur throughout pregnancy.
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Affiliation(s)
- Luís Lobo
- Hospital Veterinário do Porto, 4250-475 Porto, Portugal; (L.L.); (L.S.)
- Faculdade de Medicina Veterinária, Universidade Lusófona de Humanidades e Tecnologias, Campo Grande, 376, 1749-024 Lisboa, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | | | - Pedro Oliveira
- Davies Veterinary Specialists, Manor Farm Business Park, Hitchin SG5 3HR, UK;
| | - Luís Salazar
- Hospital Veterinário do Porto, 4250-475 Porto, Portugal; (L.L.); (L.S.)
| | - André Pereira
- Centro Hospitalar Veterinário, 4100-320 Porto, Portugal;
| | - Ana Patrícia Fontes-Sousa
- Centro de Investigação Farmacológica e Inovação Medicamentosa (MedInUP), Departamento de Imuno-Fisiologia e Farmacologia, ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
- Correspondence: ; Tel.: +351-22-0428-227
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Zhang M, Zhou J, Wang L. Breast cancer and pregnancy: Why special considerations prior to treatment are needed in multidisciplinary care. Biosci Trends 2021; 15:276-282. [PMID: 34556594 DOI: 10.5582/bst.2021.01187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Breast cancer diagnosed during pregnancy poses ethical and professional challenges. Clinical management of that condition should ensure the safety of both the mother and fetus. Clinical trials on breast cancer exclude pregnant women, so sufficient evidence with which to formulate guidelines for the management of these patients is lacking. Failing to undergo a breast examination during pregnancy, breast symptoms explained by physiological changes such as pregnancy, and unnecessary abortions after the diagnosis of breast cancer lead to worse outcomes for these patients. Multidisciplinary teams including breast surgeons, obstetricians, radiologists, pathologists, and anesthesiologists need to make an early diagnosis and comprehensively evaluate patients in different gestational weeks and with different stages of breast cancer in order to optimize outcomes.
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Affiliation(s)
- Mingdi Zhang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
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Glutamate levels in the medial prefrontal cortex of healthy pregnant women compared to non-pregnant controls. Psychoneuroendocrinology 2021; 133:105382. [PMID: 34419762 DOI: 10.1016/j.psyneuen.2021.105382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/20/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022]
Abstract
Very little is known about maternal cerebral changes during pregnancy. Since there is an increased risk for major depression during pregnancy and postpartum, it is important to understand the structural and neurochemical changes that occur in the brain during pregnancy. Using proton magnetic resonance spectroscopy (1H-MRS) (3 T field strength), glutamate (Glu) levels were measured in the medial prefrontal cortex (MPFC) of 21 healthy gravid subjects 2-3 weeks before their due date (6.74 ± 1.39), and in 14 non-pregnant healthy controls during their follicular phase (8.53 ± 1.55). Water quantified MPFC Glu levels were decreased in pregnant women (p < 0.01). We also observed a 13.9% decrease in percentage grey matter (%GM) (p < 0.01) in our MPFC voxel. As Glu is mostly found in GM, we repeated the statistical analysis after adjustment for %GM and found that the difference in Glu levels was no longer statistically significant when adjusted for %GM (p = 0.10). This investigation is the only systematic direct investigation of brain tissue composition and Glu levels in pregnant women. The main finding of this investigation is the decreased %GM in healthy pregnant women compared to non-pregnant women. These findings of decreased %GM in pregnancy may be responsible for the frequent complaints by pregnant women of cognitive difficulties also described as pregnesia.
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Anesthesia for Fetal Interventions - An Update. Adv Anesth 2021; 39:269-290. [PMID: 34715979 DOI: 10.1016/j.aan.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Liu C, Wei P, Li J. The thickness changes of retina in high myopia patients during the third trimester of pregnancy: a pilot study. BMC Ophthalmol 2021; 21:382. [PMID: 34706696 PMCID: PMC8549153 DOI: 10.1186/s12886-021-02137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives To observe and compare the difference in retinal thickness using optical coherence tomography (OCT) between patients with high myopia (HM) during the third trimester of pregnancy and age-matched HM non-pregnant women. Methods A case-control study. A total of 39 eyes from 39 HM women in the third trimester (study group) and 50 eyes of 50 age-matched non-pregnant women with HM (control group) were included. All subjects underwent SD-OCT examination. The built-in software was used to measure the retinal thickness in macular region. The data from two groups were compared using independent-samples t test. Results Among the 89 subjects in this study, the mean gestational age of the study group was 35.09 ± 2.44 weeks, and the average age was 32.24 ± 3.75 years. The average age of the control group was 34.04 ± 7.19 years old. Compared with the control group, the average thickness of parafoveal area, and the average thickness of parafoveal superior, inferior, temporal quadrants of the superficial retina and the average thickness of the foveal and parafoveal of the superficial retina were significantly decreased in the study group (P < 0.05). Compared with the control group, the average thickness of all quadrants of the retina in the parafoveal area except the nasal quadrant were significantly decreased in the study group (P < 0.05). Conclusions In this observational study, the retinal thickness of patients with high myopia during the third trimester of pregnancy was thinner than that of non-pregnant women with age-matched high myopia.
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Affiliation(s)
- Chenchen Liu
- Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Puying Wei
- Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jun Li
- Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Izzati D, Dewi ER, Rahmawati NA, Sari VR, Azmi AZ, Prasetyo B. Self-concept Factor Influencing Antenatal Provider Selection: A Qualitative Study from Indonesian Midwives. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The different philosophies of care between midwives and obstetricians influence maternal health services. Midwives deliver a holistic physiological approach, while obstetricians implement a medical approach and a technocratic model. Different perspectives in interpreting professional philosophies may impact the choices of antenatal providers for midwives, themselves. This study aims to determine the self-concept of Indonesian midwives in interpreting professional philosophy regarding the decision-making of the antenatal provider during pregnancies.
Materials and Methods: A qualitative descriptive with a phenomenological approach was carried out. It used a purposive sampling method. This study involves 15 midwives who are still active in providing services in private midwifery practices, primary health centers, and hospitals that had experienced pregnancy. The variable was the perspective of midwives in choosing ANC providers considering the self-concept. Data obtained by in-depth interview technique for 60-90 minutes duration and is analyzed using thematic analysis techniques.
Results: As the results, the selection of ANC providers has been shaped by the self-concept factor. Most perspectives are influenced by (1) knowledge of the physiological and high-risk of pregnancy concept (2) previous experiences in pregnancy/ childbirth/ after birth (3) role in families when addressing reproductive health decisions. Conversely, education level and work experiences did not affect the option to have antenatal care.
Conclusion: Self-concept influences midwives’ perspective of making decisions about ANC providers. This study shows there is a limited understanding of the philosophy of midwifery care which reflects on the decision-making of the midwives in regard to the care received during the pregnancy.
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21
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Shteinberg M, Taylor-Cousar JL, Durieu I, Cohen-Cymberknoh M. "Fertility and Pregnancy in Cystic fibrosis". Chest 2021; 160:2051-2060. [PMID: 34284004 DOI: 10.1016/j.chest.2021.07.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
People with Cystic fibrosis (pwCF) have experienced increased survival and wellbeing in recent decades, such that more than half of those living with CF are adults. Consequently, sexual and reproductive health is increasingly important for pwCF as many are considering parenthood. Most men and some women with CF (wwCF) will have reduced fertility, which in both sexes is multifactorial. However, unplanned pregnancies in women are not rare, and contraception and its interaction with CF complications need to be addressed by the CF team. Reduced fertility may be overcome in most pwCF through use of assisted reproductive technologies; however, the risk of having offspring with CF must be considered. Most wwCF will have normal pregnancies, but premature birth is common especially in the setting of reduced lung function and CF related diabetes (CFRD); optimization of treatment is recommended during pregnancy planning. Parenting imposes an increased burden on pwCF, with the challenges of caring for the newborn, postpartum physiologic changes and maintaining CF treatments. Most drugs used to treat CF are considered safe in pregnancy and lactation, but exceptions need to be acknowledged, including the limited data regarding safety of CF transmembrane conductance regulator (CFTR) modulators during conception, pregnancy, and lactation. As most pwCF are eligible for highly effective CFTR modulators, fertility, contraception, and pregnancy in people with CF is changing. Prospective studies regarding these issues in people treated with CFTR modulators are paramount to provide evidence-based guidance for management in the current era of CF care.
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Affiliation(s)
- Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center and the Technion-Israel Institute of Technology, Haifa, Israel.
| | - Jennifer L Taylor-Cousar
- Divisions of Pulmonary, Critical Care and Sleep Medicine and Pediatric Pulmonary Medicine, National Jewish Health, Denver, CO
| | - Isabelle Durieu
- RESearch on HealthcAre PErformance (RESHAPE), Lyon University, Lyon, and Hospices Civils de Lyon, Lyon Sud Hospital, Cystic Fibrosis Center, Lyon, France
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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22
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Corneal Biomechanical Changes in Third Trimester of Pregnancy. ACTA ACUST UNITED AC 2021; 57:medicina57060600. [PMID: 34200925 PMCID: PMC8230443 DOI: 10.3390/medicina57060600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022]
Abstract
Background and Objectives: There is a clear evidence that pregnancy is associated with high production of sex hormones. During the first, second and third trimester of pregnancy, blood hormones levels increase gradually. Cells with affinity for sex hormones have been identified in different ocular tissues, such as: lid, lacrimal gland, meibomian gland, bulbar and palpebral conjunctivae, cornea, iris, ciliary body, lens, retina (retinal pigment epithelium) and choroid. This is why pregnancy is associated with changes at ocular level, involving anterior and posterior segments. Several clinical trials have been made trying to highlight changes in corneal biomechanics during pregnancy. By conducting this review, we want to evaluate both the changes in parameters that define corneal biomechanics and intraocular pressure values in pregnant. Materials and Methods: Following a systematic search in the literature related mainly to changes in corneal biomechanics during pregnancy, focusing on the paper published in the last decade, we included in a meta-analysis the cumulative results of three prospective comparative studies. Results: Important changes in corneal biomechanics (corneal hysteresis and corneal resistance factor) parameters were observed in women in the third trimester of pregnancy, but these variations were not statistically significant. Also, a decrease in intraocular pressure was mentioned in these women, but only the corneal compensation intraocular pressure showed a decrease with statistical significance. Conclusions: A decrease in corneal compensatory intraocular pressure was observed in pregnant women in the third trimester of pregnancy, but without other statistically significant changes resulting from the analysis of the other three parameters (corneal hysteresis, corneal resistance factor and Goldmann-correlated intraocular pressure).
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MENG YU, YANG LIN, ZHANG SONG, WU GUANGHUI, LIU XIAOHONG, HAO DONGMEI, YANG YIMIN, LI XUWEN. CHANGES IN GAUSSIAN MODELING PARAMETERS OF PPG PULSE DURING HEALTHY PREGNANCY. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We used Gaussian modeling to depict the changes in finger photoplethysmographic (PPG) pulse during pregnancy in healthy women. We enrolled 70 healthy pregnant women and recorded their PPG pulses in 11–13 gestational weeks, 20–22 gestational weeks, and 37–39 gestational weeks. Three independent positive Gaussian functions were utilized to decompose the pulses, and each Gaussian function extracted three key parameters: the peak amplitude ([Formula: see text]), the peak position ([Formula: see text]), and the half-width ([Formula: see text]). The method of ANOVA and post-hoc multiple comparisons of mathematical statistics were utilized to study the differences of these parameters between the three trimesters. We found that in the first trimester [Formula: see text] increased significantly ([Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]). [Formula: see text] and [Formula: see text] increased in the first trimester ([Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]; [Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]), then decreased significantly ([Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]). [Formula: see text] is associated with cardiac output, and [Formula: see text] and [Formula: see text] are associated with peripheral vascular resistance. The results of this study were consistent with the conclusion that healthy pregnant women exhibited high flow state of the cardiovascular system and their peripheral vascular resistance decreased first and then gradually recovered during pregnancy. This study indicated that PPG pulse could also reflect the changes in the maternal cardiovascular system during pregnancy.
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Affiliation(s)
- YU MENG
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100024, P. R. China
| | - LIN YANG
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100024, P. R. China
| | - SONG ZHANG
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100024, P. R. China
| | - GUANGHUI WU
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China
| | - XIAOHONG LIU
- Beijing Yes Medical Devices Co., Ltd., Beijing 100152, P. R. China
| | - DONGMEI HAO
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100024, P. R. China
| | - YIMIN YANG
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100024, P. R. China
| | - XUWEN LI
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100024, P. R. China
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Shim KY, Bae JG, Lee JK, Kim YC. Relationship between proteinuria and optical coherence tomographic features of the chorioretina in patients with pre-eclampsia. PLoS One 2021; 16:e0251933. [PMID: 34015042 PMCID: PMC8136667 DOI: 10.1371/journal.pone.0251933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
This retrospective study aimed to evaluate the correlation between ophthalmologic factors and proteinuria in patients with pre-eclampsia using swept-source optical coherence tomography (OCT) and OCT angiography. In total, 61 pregnant patients diagnosed with pre-eclampsia were recruited during their hospital stay. The authors investigated the relationship between urine protein–creatinine ratio (PCR) and chorioretinal measurements including choroidal thickness (CT), choroidal vascularity index (CVI), foveal avascular zone (FAZ), vascular density (VD), ganglion cell layer+ (GCL+) and GCL++. The associations between mean arterial pressure (MAP) and ophthalmologic factors were also evaluated. Central subfield CT of the right eye (p = 0.031) and paracentral CT of both eyes were related to higher PCR (≥1.35 mg/mg). A significant association with PCR after logarithm transformation was noted (r = 0.284, p = 0.026). Retinal measurements (FAZ, VD, GCL+ and GCL++) and CVI were not related with PCR. There was a positive association between MAP and PCR after logarithm transformation (r = 0.296, p = 0.021); however, chorioretinal factors were not related with MAP. In pregnant women with pre-eclampsia, CT using OCT is a novel factor that is correlated with PCR. Ocular structural alteration in patients with pre-eclampsia may be one of systemic vascular changes caused by pre-eclampsia rather than hypertension.
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Affiliation(s)
- Kyu Young Shim
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Gon Bae
- Department of Obstetrics, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Kyoung Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
- * E-mail:
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Wallberg CD, Smart DM, Mackelprang JL, Graves JM. Stair-Related Injuries Among Pregnant Women Treated in United States Emergency Departments. Matern Child Health J 2021; 25:892-899. [PMID: 33948829 DOI: 10.1007/s10995-021-03141-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Falls are one of the leading causes of trauma during pregnancy, and most falls occur on stairs. The purpose of this study was to describe stair-related falls among pregnant women who were treated in United States emergency departments during a 10-year period. METHODS This study utilized a cross-sectional analysis of National Electronic Injury Surveillance System (NEISS) data, 2008-2017. Emergency department visits by pregnant women aged 12 years and older were identified using case narratives. RESULTS From 2008 to 2017, 1466 cases of pregnant women who had sustained stair-related falls were reported to NEISS, equating to a national estimate of 57,512 over the 10-year study period. Variables examined included age, body part injured, location of injury, discharge disposition, gestation, mechanism of injury, and other fall-associated hazards and symptoms. Most injuries involved contusions or abrasions, other injuries commonly reported were sprains/strains and contusions/abrasions. Wet/icy conditions represented hazards associated with 4.1% of all injuries. Severe obstetric symptoms, such as decreased fetal movement and vaginal bleeding, were described in study narratives. CONCLUSIONS Falls are a leading cause of injury among women of childbearing age and stair-related falls comprise a large proportion of maternal falls. Physiological changes associated with pregnancy can put gravid women at greater risk for falls. Healthcare providers can provide women anticipatory guidance that may reduce their risk for falls as they progress in pregnancy.
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Affiliation(s)
- Cassandra D Wallberg
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99201, USA
- Honors College, Washington State University, Pullman, WA, USA
| | - Denise M Smart
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99201, USA
- Honors College, Washington State University, Pullman, WA, USA
| | - Jessica L Mackelprang
- Department of Psychological Sciences, Faculty of Health, Arts and Design School of Health Sciences, Swinburne University of Technology, Melbourne ATC 911, Hawthorn, VIC, 3122, Australia
| | - Janessa M Graves
- College of Nursing, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99201, USA.
- Honors College, Washington State University, Pullman, WA, USA.
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Abstract
BACKGROUND In the United States, drug addiction has become a nationwide health crisis. Recently, buprenorphine (BUP), a maintenance therapy approved by the Food and Drug Administration, has been increasingly used in pregnant women for the treatment of opioid use disorder. Pregnancy is associated with various anatomic and physiological changes, which may result in altered drug pharmacokinetics (PKs). Previously, we reported that dose-adjusted plasma concentrations of BUP are lower during pregnancy than after pregnancy. The mechanism(s) responsible for this difference has not yet been defined. Our study aimed to evaluate alterations in cytochromes P450 (CYP)- and uridine diphosphate glucunosyltransferases (UGT)-mediated metabolism of BUP during pregnancy to determine the mechanism(s) responsible for this observation. METHODS Data from 2 clinical studies were included in the current analysis. Study 1 was a prospective, open-labeled, nonrandomized longitudinal BUP PK study in pregnant women with a singleton gestation, stabilized on twice-daily sublingual BUP opioid substitution therapy. Each subject participated in up to 3 studies during and after pregnancy (the second, third trimester, and postpartum). The design of study 2 was similar to study 1, with patients evaluated at different time points during the pregnancy (first, second-half of pregnancy), as well as during the postpartum period. In addition, the dosing frequency of BUP study 2 participants was not restricted to twice-daily dosing. At each study visit, blood samples were collected before a BUP dose, followed by multiple collection times (10-12) after the dose, for up to 12 hours or till the end of the dosing interval. Plasma concentrations of BUP and 3 metabolites were quantified using validated ultraperformance liquid chromatography-tandem mass spectrometric assays. RESULTS In total, 19, 18, and 14 subjects completed the PK study during 1/2 trimester, third trimester, and postpartum, respectively. The AUC ratios of norbuprenorphine and norbuprenorphine glucuronide to buprenorphine, a measure of CYP3A mediated N-demethylation, were 1.89, 1.84, and 1.33 during the first and second, third trimesters, and postpartum, respectively. The AUC ratios of buprenorphine glucuronide to BUP, indicative of UGT activity, were 0.71, 2.07, and 0.3 at first/second trimesters, third trimester, and postpartum, respectively. Linear mixed-effect modeling analysis indicated that the AUC ratios of CYP- and UGT-mediated metabolism of BUP were significantly higher during pregnancy compared with postpartum. CONCLUSIONS The CYP and UGT activities were significantly increased as determined by the metabolic ratios of BUP during pregnancy compared with the postpartum period. The increased UGT activity appeared to account for a substantial part of the observed change in metabolic activity during pregnancy. This is in agreement with the need for BUP dose increment in pregnant women to reach similar BUP exposure and therapeutic effect as in nonpregnant subjects.
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van Amesfoort JE, Werter DE, Painter RC, Hermans FJR. Severe metabolic ketoacidosis as a primary manifestation of SARS-CoV-2 infection in non-diabetic pregnancy. BMJ Case Rep 2021; 14:14/4/e241745. [PMID: 33875510 PMCID: PMC8057576 DOI: 10.1136/bcr-2021-241745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We present a case of a metabolic acidosis in a term-pregnant woman with SARS-CoV-2 infection. Our patient presented with dyspnoea, tachypnoea, thoracic pain and a 2-day history of vomiting, initially attributed to COVID-19 pneumonia. Differential diagnosis was expanded when arterial blood gas showed a high anion gap metabolic non-lactate acidosis without hypoxaemia. Most likely, the hypermetabolic state of pregnancy, in combination with maternal starvation and increased metabolic demand due to infection, had resulted in metabolic ketoacidosis. Despite supportive treatment and rapid induction of labour, maternal deterioration and fetal distress during labour necessitated an emergency caesarean section. The patient delivered a healthy neonate. Postpartum, after initial improvement in metabolic acidosis, viral and bacterial pneumonia with subsequent significant respiratory compromise were successfully managed with oxygen supplementation and corticosteroids. This case illustrates how the metabolic demands of pregnancy can result in an uncommon presentation of COVID-19.
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Affiliation(s)
| | - Dominique E Werter
- Obstetrics & Gynaecology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Rebecca C Painter
- Obstetrics & Gynaecology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Frederik J R Hermans
- Obstetrics & Gynaecology, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
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Validation and reproducibility of a FFQ focused on pregnant women living in Northeastern Brazil. Public Health Nutr 2021; 24:5769-5776. [PMID: 33563352 DOI: 10.1017/s1368980021000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the current study is to assess the validity and reproducibility of a FFQ focused on pregnant women living in Northeastern Brazil. DESIGN Three 24-hour-dietary recalls (24 hR) and two FFQ were applied at 15-d intervals between research stages in order to confirm the validity and reproducibility of the FFQ. Validity assessment was based on Pearson's correlation coefficient (PCC) or Spearman's correlation coefficient (SCC) between FFQ and the mean of three 24 hR (the 24 hR was used as reference standard), whereas reproducibility assessment was based on the intraclass correlation coefficient (ICC) among FFQ, and P < 0·05 was set as significance level. SETTING Public health network of a capital city in Northeastern Brazil. PARTICIPANTS Overall, 100 pregnant women were included in the study. RESULTS The PCC or SCC adopted in the validity analysis recorded the recommended values (from 0·4 and 0·7) for energy (0·44; P < 0·001), carbohydrate (0·40; P < 0·001), vitamins B2 (0·40; P < 0·001), B5 (0·40; P < 0·001), E (0·47; P < 0·001), B12 (0·48; P < 0·001), phosphorus (0·92; P < 0·001), Mg (0·81; P < 0·001), Se (0·70; P < 0·001), cholesterol (0·64; P < 0·001), saturated (0·76; P < 0·001), polyunsaturated (0·73; P < 0·001) and monounsaturated fats (0·87; P < 0·001) and fibres (0·77; P < 0·001). Mg (0·72; P < 0·001), Fe (0·65; P < 0·001), lipid (0·56; P < 0·001) and energy (0·55; P < 0·001) presented ICC within the recommended reproducibility values. CONCLUSIONS The FFQ developed in the current study is a useful tool to assess the usual food intake of pregnant women.
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Garczyńska K, Tzschätzsch H, Kühl AA, Morr AS, Lilaj L, Häckel A, Schellenberger E, Berndt N, Holzhütter HG, Braun J, Sack I, Guo J. Changes in Liver Mechanical Properties and Water Diffusivity During Normal Pregnancy Are Driven by Cellular Hypertrophy. Front Physiol 2020; 11:605205. [PMID: 33329058 PMCID: PMC7719759 DOI: 10.3389/fphys.2020.605205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
During pregnancy, the body’s hyperestrogenic state alters hepatic metabolism and synthesis. While biochemical changes related to liver function during normal pregnancy are well understood, pregnancy-associated alterations in biophysical properties of the liver remain elusive. In this study, we investigated 26 ex vivo fresh liver specimens harvested from pregnant and non-pregnant rats by diffusion-weighted imaging (DWI) and magnetic resonance elastography (MRE) in a 0.5-Tesla compact magnetic resonance imaging (MRI) scanner. Water diffusivity and viscoelastic parameters were compared with histological data and blood markers. We found livers from pregnant rats to have (i) significantly enlarged hepatocytes (26 ± 15%, p < 0.001), (ii) increased liver stiffness (12 ± 15%, p = 0.012), (iii) decreased viscosity (−23 ± 14%, p < 0.001), and (iv) increased water diffusivity (12 ± 11%, p < 0.001). In conclusion, increased stiffness and reduced viscosity of the liver during pregnancy are mainly attributable to hepatocyte enlargement. Hypertrophy of liver cells imposes fewer restrictions on intracellular water mobility, resulting in a higher hepatic water diffusion coefficient. Collectively, MRE and DWI have the potential to inform on structural liver changes associated with pregnancy in a clinical context.
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Affiliation(s)
- Karolina Garczyńska
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja A Kühl
- iPATH.Berlin Core Unit, Charitá - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna Sophie Morr
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ledia Lilaj
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Akvile Häckel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eyk Schellenberger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nikolaus Berndt
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Computational Systems Biochemistry Group, Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hermann-Georg Holzhütter
- Computational Systems Biochemistry Group, Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jing Guo
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Amare YE, Haile D. Evaluation of Pulmonary Function Tests Among Pregnant Women of Different Trimesters in Debre Berhan Referral Hospital, Shoa, Ethiopia. Int J Womens Health 2020; 12:1135-1143. [PMID: 33324115 PMCID: PMC7732161 DOI: 10.2147/ijwh.s275742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Pregnancy is characterized by a sequence of dynamic physiological changes that impact multiple organ system functions and is associated with various changes in pulmonary anatomy and physiology. Precise knowledge of the pulmonary function test parameters helps to understand and manage the course and outcome of pregnancy leading to safe delivery. It also helps to avoid misdiagnosis and unnecessary interventions. The aim of this study was to evaluate the effect of normal pregnancy on pulmonary function tests among pregnant women in Debre Berhan Referral Hospital, Ethiopia. Methods A total of 176 study participants (first, second, and third trimester; and control) were involved under a comparative cross-sectional study design and convenience sampling technique. Anthropometric data, oxygen saturation of arterial blood, and pulmonary function tests were measured. Data were tabulated and statistically analyzed using SPSS version 20.0 statistical software. Means of all parameters were compared using one-way ANOVA followed by Tukey’s post hoc multiple comparison test. Statistical significance was preset at a p-value of less than 0.05. Results Mean of FVC for the controls, first, second, and third trimesters was 2.59 ± 0.26, 2.13 ± 0.15, 1.93 ± 0.27, and 1.90 ± 0.11 liters, respectively. Except for FEV1%, the mean values of FVC, FEV1, PEFR, and FEF 25–75% in the pregnant group (all the three trimesters) were significantly decreased from the controls (P<0.05). Strong negative correlation was seen between SaO2 and RR (r= −0.865; P <0.01). As the pregnancy progressed from first to the third trimester, dynamic pulmonary function tests (FVC, FEV1, FEF25-75%, and PEFR) were dropped and the respiratory rate increased. Conclusion The results had shown the tendency of obstructive pattern while pregnancy becoming advanced. We have observed also a remarkable decline of SaO2 in pregnant women that might be counterbalanced by raised respiratory rate.
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Affiliation(s)
- Yosef Eshetie Amare
- Department of Biomedical Sciences, Institute of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Diresibachew Haile
- Department of Physiology, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Prado-Nóvoa O, Rodríguez J, Martín García A, Mateos A. Body composition helps: Differences in energy expenditure between pregnant and nonpregnant females. Am J Hum Biol 2020; 33:e23518. [PMID: 33155733 DOI: 10.1002/ajhb.23518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Human pregnancy is associated with important physiological changes that usually increase energetic requirements. However, great variability exists in the costs and mechanisms required to bear pregnancy. Since body mass (BM) and composition are modified during gestation, it is of great interest to compare the influence of BM on energy expenditure (EE) in pregnant and nonpregnant females. METHODS BM, body composition, and EE of 77 volunteers (35 pregnant and 42 nonpregnant females) were measured. The pregnant volunteers completed two measurement rounds at 28 and 32 gestation weeks. Differences on the measured parameters were sought, and comparison of regression lines was computed to test how BM affected the EE of the volunteers. RESULTS BM and body composition parameters are significantly higher in pregnant females, but EE is not statistically different. Pregnant females have a larger percentage of fat mass, but lower percentage of fat-free mass (FFM). The EE per kg of FFM is similar in both groups. Comparison of regression lines shows that pregnancy does not change the relationship between BM and EE, but for similar BM pregnant females expend less energy than nonpregnant females. CONCLUSIONS We propose that their larger percentage of passive body tissues is the reason why pregnant females expend less energy than nonpregnant females of similar BM, without changing the scaling of EE on BM. Thus, pregnancy could not be as energetically constraining as usually assumed, with important consequences for human reproductive ecology.
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Affiliation(s)
- Olalla Prado-Nóvoa
- Postgraduate School of Human Evolution, University of Burgos, Burgos, Spain
| | - Jesús Rodríguez
- Paleobiology Program, National Research Center on Human Evolution (CENIEH), Burgos, Spain
| | - Adrián Martín García
- Gynecology and Obstetrics Department, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Ana Mateos
- Paleobiology Program, National Research Center on Human Evolution (CENIEH), Burgos, Spain
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Gao Y, Jia J, Liu X, Guo S, Ming L. Trimester-Specific Reference Intervals of Serum Urea, Creatinine, and Uric Acid Among Healthy Pregnant Women in Zhengzhou, China. Lab Med 2020; 52:267-272. [PMID: 33145592 DOI: 10.1093/labmed/lmaa088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To verify the differences in serum levels of urea, creatinine, and uric acid (UA) between pregnant and nonpregnant women and establish specific reference intervals of serum urea, creatinine, and UA for pregnant women, and thus help for the detection of kidney disease in pregnancy. METHODS Based on the selection criteria, 1312 apparently healthy pregnant women and 1301 nonpregnant women were enrolled in this study. The levels of serum urea, creatinine, and UA were compared between the pregnant and nonpregnant women. The differences in the 3 indicators among different age groups and trimesters in pregnant women were studied. Finally, reference intervals were established by nonparametric methods according to the recommendation of Clinical and Laboratory Standards Institute guideline C28-A3. RESULTS Compared with nonpregnant women, pregnant women had a significantly lower level of serum urea, creatinine, and UA (all P <.01), and no significant age-related differences in the 3 indicators were observed among the pregnant women (P >.05). However, the levels of these indicators were significantly different among the 3 trimesters (all P <.01 or P =.01). Accordingly, trimester-specific reference intervals of serum urea (1.6-4.4 mmol/L; 1.6-4.2 mmol/L; 1.6-4.4 mmol/L), creatinine (36-68 μmol/L; 34-66 μmol/L; 36-68 μmol/L), and UA (122-297 μmol/L; 129-327 μmol/L; 147-376 μmol/L) for trimesters 1, 2, and 3, respectively, were established. CONCLUSION These newly established reference intervals will be valuable for the detection and monitoring of kidney disease in pregnancy.
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Affiliation(s)
- Yuhua Gao
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia Jia
- School of Environment, Beijing Normal University, Beijing, China
| | - Xianan Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuren Guo
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Ming
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Schroder TH, Tan A, Mattman A, Sinclair G, Barr SI, Vallance HD, Lamers Y. Reference intervals for serum total vitamin B12 and holotranscobalamin concentrations and their change points with methylmalonic acid concentration to assess vitamin B12 status during early and mid-pregnancy. Clin Chem Lab Med 2020; 57:1790-1798. [PMID: 31085739 DOI: 10.1515/cclm-2018-1337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/05/2019] [Indexed: 11/15/2022]
Abstract
Background Maternal vitamin B12 (B-12) adequacy is important for maternal health and optimal fetal growth. However, pregnancy-specific cut-offs for B-12 biomarkers are lacking. Methods Reference intervals for serum total B-12, holotranscobalamin (holoTC) and methylmalonic acid (MMA) concentrations were calculated following CLSI EP28-A3c guidelines in 723 pregnant women of European (50%) and South Asian (50%) ethnicity, residing in British Columbia, Canada, at median (range) 11.4 (8.3-13.9) and 16.1 (14.9-20.9) weeks of gestation. Change point analyses described relationships between log serum MMA concentration with serum total B-12 and holoTC concentrations, assuming linear-linear relationships. Results The central 95% reference interval limits indicated that serum total B-12 <89.9 and <84.0 pmol/L, holoTC <29.5 and <26.0 pmol/L and MMA >371 and >374 nmol/L, in the first and second trimesters, respectively, may indicate B-12 deficiency in pregnant women. The lower limits of total B-12 and holoTC and the upper limits of MMA significantly differed by ethnicity in both trimesters. According to the change point analysis, total B-12 <186 and <180 pmol/L and holoTC <62.2 and <67.5 pmol/L in the first and second trimesters, respectively, suggested an increased probability of impaired intracellular B-12 status, with no difference between ethnicities. Conclusions We present novel reference limits and change points for B-12 biomarkers, which may be employed to identify possible B-12 deficiency in women during early and mid-pregnancy. Future research is needed to validate these cut-offs and determine the predictors and functional outcomes associated with impaired B-12 status in ethnically diverse populations.
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Affiliation(s)
- Theresa H Schroder
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Amy Tan
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Andre Mattman
- Department of Clinical Chemistry and Laboratory Medicine, St Paul's Hospital, Vancouver, BC, Canada
| | - Graham Sinclair
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital and BC Women's Health Centre, Vancouver, BC, Canada
| | - Susan I Barr
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Hilary D Vallance
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital and BC Women's Health Centre, Vancouver, BC, Canada
| | - Yvonne Lamers
- British Columbia Children's Hospital Research Institute, 950 W 28th Ave, Vancouver, BC V5Z 4H4, Canada.,Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, FNH 245, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada
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Cohen-Cymberknoh M, Gindi Reiss B, Reiter J, Lechtzin N, Melo J, Pérez G, Blau H, Mussaffi H, Levine H, Bentur L, Gur M, Livnat G, Perez Miranda J, Polverino E, Blasi F, Aliberti S, Aviram M, Golan Tripto I, Picard E, Novoselsky M, Amsalem H, Hochner Celnikier D, Kerem E, Shteinberg M. Baseline Cystic fibrosis disease severity has an adverse impact on pregnancy and infant outcomes, but does not impact disease progression. J Cyst Fibros 2020; 20:388-394. [PMID: 32917549 DOI: 10.1016/j.jcf.2020.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND With increasing longevity and quality of life in adults with Cystic fibrosis (CF), growing maternity rates are reported. Women with severe CF are becoming pregnant, with unpredictable maternal and fetal outcomes. AIM To determine how baseline disease severity, pancreatic insufficiency (PI) and Pseudomonas aeruginosa (PA) infection affect fertility, the pregnancy course, delivery, neonatal outcome, and subsequent disease progression. METHODS A multicenter-retrospective cohort study. Data on patients that had been pregnant between 1986-2018 was collected from ten CF centers worldwide. Disease severity [mild or moderate-severe (mod-sev)] was defined according to forced expiratory volume % predicted in 1 second (FEV1) and body mass index (BMI). Three time periods were compared, 12 months prior to conception, the pregnancy itself and the 12 months thereafter. RESULTS Data was available on 171 pregnancies in 128 patients aged 18-45 years; 55.1% with mod-sev disease, 43.1% with PI and 40.3% with PA. Women with mod-sev disease had more CF-related complications during and after pregnancy and delivered more preterm newborns. However, FEV1 and BMI decline were no different between the mild and mod-sev groups. A more rapid decline in FEV1 was observed during pregnancy in PI and PA infected patients, though stabilizing thereafter. PI was associated with increased risk for small for gestational age infants. CONCLUSION Baseline disease severity, PA infection and PI have an adverse impact on infant outcomes, but do not impact significantly on disease progression during and after pregnancy. Consequently, pregnancies in severe CF patients can have a good prognosis.
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Affiliation(s)
| | | | - Joel Reiter
- CF Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Noah Lechtzin
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joel Melo
- Instituto Nacional del Tórax, Santiago, Chile
| | - Gema Pérez
- Instituto Nacional del Tórax, Santiago, Chile
| | - Hannah Blau
- Graub CF Center of Schneider Children's Medical Center, Petach-Tikva and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Huda Mussaffi
- Graub CF Center of Schneider Children's Medical Center, Petach-Tikva and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Hagit Levine
- Graub CF Center of Schneider Children's Medical Center, Petach-Tikva and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Lea Bentur
- CF Center, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Michal Gur
- CF Center, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Galit Livnat
- (7)Pulmonology institute and CF Center, Carmel Medical Center and the Technion- Israel Institute of Technology, Haifa, Israel
| | | | - Eva Polverino
- CF Center, Hospital Universitari Vall d'Hebron Barcelona, Spain
| | - Francesco Blasi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Adult CF Center, and Department Pathophysiology and Transplantation University of Milan, Italy
| | - Stefano Aliberti
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Adult CF Center, and Department Pathophysiology and Transplantation University of Milan, Italy
| | | | | | - Elie Picard
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michal Novoselsky
- Department of Obstetrics and Gynecology, Mount Scopus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Amsalem
- Department of Obstetrics and Gynecology, Mount Scopus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Drorith Hochner Celnikier
- Department of Obstetrics and Gynecology, Mount Scopus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eitan Kerem
- CF Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Shteinberg
- (7)Pulmonology institute and CF Center, Carmel Medical Center and the Technion- Israel Institute of Technology, Haifa, Israel
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Aleksenko L, Quaye IK. Pregnancy-induced Cardiovascular Pathologies: Importance of Structural Components and Lipids. Am J Med Sci 2020; 360:447-466. [PMID: 32540145 DOI: 10.1016/j.amjms.2020.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/09/2020] [Accepted: 05/07/2020] [Indexed: 01/22/2023]
Abstract
Pregnancy leads to adaptations for maternal and fetal energy needs. The cardiovascular system bears the brunt of the adaptations as the heart and vessels enable nutrient supply to maternal organs facilitated by the placenta to the fetus. The components of the cardiovascular system are critical in the balance between maternal homeostatic and fetus driven homeorhetic regulation. Since lipids intersect maternal cardiovascular function and fetal needs with growth and in stress, factors affecting lipid deposition and mobilization impact risk outcomes. Here, the cardiovascular components and functional derangements associated with cardiovascular pathology in pregnancy, vis-à-vis lipid deposition, mobilization and maternal and/or cardiac and fetal energy needs are detailed. Most reports on the components and associated pathology in pregnancy, are on derangements affecting the extracellular matrix and epicardial fat, followed by the endothelium, vascular smooth muscle, pericytes and myocytes. Targeted studies on all cardiovascular components and pathological outcomes in pregnancy will enhance targeted interventions.
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Affiliation(s)
- Larysa Aleksenko
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Isaac K Quaye
- Regent University College of Science and Technology, Accra, Ghana
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36
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Broere-Brown ZA, Adank MC, Benschop L, Tielemans M, Muka T, Gonçalves R, Bramer WM, Schoufour JD, Voortman T, Steegers EAP, Franco OH, Schalekamp-Timmermans S. Fetal sex and maternal pregnancy outcomes: a systematic review and meta-analysis. Biol Sex Differ 2020; 11:26. [PMID: 32393396 PMCID: PMC7216628 DOI: 10.1186/s13293-020-00299-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
Background Since the placenta also has a sex, fetal sex–specific differences in the occurrence of placenta-mediated complications could exist. Objective To determine the association of fetal sex with multiple maternal pregnancy complications. Search strategy Six electronic databases Ovid MEDLINE, EMBASE, Cochrane Central, Web-of-Science, PubMed, and Google Scholar were systematically searched to identify eligible studies. Reference lists of the included studies and contact with experts were also used for identification of studies. Selection criteria Observational studies that assessed fetal sex and the presence of maternal pregnancy complications within singleton pregnancies. Data collection and analyses Data were extracted by 2 independent reviewers using a predesigned data collection form. Main results From 6522 original references, 74 studies were selected, including over 12,5 million women. Male fetal sex was associated with term pre-eclampsia (pooled OR 1.07 [95%CI 1.06 to 1.09]) and gestational diabetes (pooled OR 1.04 [1.02 to 1.07]). All other pregnancy complications (i.e., gestational hypertension, total pre-eclampsia, eclampsia, placental abruption, and post-partum hemorrhage) tended to be associated with male fetal sex, except for preterm pre-eclampsia, which was more associated with female fetal sex. Overall quality of the included studies was good. Between-study heterogeneity was high due to differences in study population and outcome definition. Conclusion This meta-analysis suggests that the occurrence of pregnancy complications differ according to fetal sex with a higher cardiovascular and metabolic load for the mother in the presence of a male fetus. Funding None.
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Affiliation(s)
- Zoe A Broere-Brown
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maria C Adank
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Laura Benschop
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Myrte Tielemans
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Taulant Muka
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Romy Gonçalves
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Hogeschool van Amsterdam (HvA), Amsterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sarah Schalekamp-Timmermans
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands. .,Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands.
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37
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Okeagu CN, Anandi P, Gennuso S, Hyatali F, Stark CW, Prabhakar A, Cornett EM, Urman RD, Kaye AD. Clinical management of the pregnant patient undergoing non-obstetric surgery: Review of guidelines. Best Pract Res Clin Anaesthesiol 2020; 34:269-281. [PMID: 32711833 DOI: 10.1016/j.bpa.2020.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
The management principles of non-obstetric surgery during pregnancy are important concepts for all health care providers to be cognizant of. The goals of non-obstetric surgery are to ensure maternal safety, maintain the pregnancy, and ensure fetal well-being. In this regard, organogenesis occurs roughly between days 7-57 and thus, certain medications have a higher incidence of fetal teratogenicity in this first trimester. Some examples of common surgeries performed urgently or emergently include appendectomies, ovarian detorsions, bowel obstruction, trauma, and cholecystectomies. The choice of anesthetic technique and the selection of appropriate anesthetic drugs should be guided by indication for surgery, the nature of the surgery, and the site of the surgical procedure. Many of the concerns for any patients undergoing urgent or emergent surgery must be considered by anesthesia providers along with steps to ensure the fetus has the best outcome.
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Affiliation(s)
- Chikezie N Okeagu
- Department of Anesthesiology, LSU Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA.
| | | | - Sonja Gennuso
- Director of Pediatric Anesthesiology, Assistant Program Director, Department of Anesthesiology, LSU Health Shreveport, USA.
| | - Farees Hyatali
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Cain W Stark
- Medical College of Wisconsin, 8701 West Watertown Plank Road, Wauwatosa, WI, 53226, USA.
| | - Amit Prabhakar
- Emory School of Medicine, Department of Anesthesiology, Division of Critical Care, Atlanta GA USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Alan David Kaye
- LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
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Courtney AU, O’Brien EC, Crowley RK, Geraghty AA, Brady MB, Kilbane MT, Twomey PJ, McKenna MJ, McAuliffe FM. DASH (Dietary Approaches to Stop Hypertension) dietary pattern and maternal blood pressure in pregnancy. J Hum Nutr Diet 2020; 33:686-697. [DOI: 10.1111/jhn.12744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- A. U. Courtney
- UCD Perinatal Research Centre School of Medicine University College DublinNational Maternity Hospital Dublin Ireland
| | - E. C. O’Brien
- UCD Perinatal Research Centre School of Medicine University College DublinNational Maternity Hospital Dublin Ireland
| | - R. K. Crowley
- Department of Endocrinology St Vincent’s University Hospital Dublin Ireland
| | - A. A. Geraghty
- UCD Perinatal Research Centre School of Medicine University College DublinNational Maternity Hospital Dublin Ireland
| | - M. B. Brady
- UCD Perinatal Research Centre School of Medicine University College DublinNational Maternity Hospital Dublin Ireland
| | - M. T. Kilbane
- Department of Clinical Chemistry St Vincent’s University Hospital Dublin Ireland
| | - P. J. Twomey
- Department of Clinical Chemistry St Vincent’s University Hospital Dublin Ireland
| | - M. J. McKenna
- UCD Perinatal Research Centre School of Medicine University College DublinNational Maternity Hospital Dublin Ireland
- Department of Endocrinology St Vincent’s University Hospital Dublin Ireland
| | - F. M. McAuliffe
- UCD Perinatal Research Centre School of Medicine University College DublinNational Maternity Hospital Dublin Ireland
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Silva M, Ribeiro Filho J, Dantas W, Valente F, Ribeiro B, Ermita P, Monteiro L, Costa C, Silva G, Alves S, Avanza M, Santos P, Manso Filho H. Hematological and biochemical profiles of Mangalarga Marchador mares in the transition period bred on pasture. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-11142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The present study aimed to evaluate the effects of the transition period on hematological and biochemical constituents in Mangalarga Marchador mares. Forty-eight mares were used to form a maintenance group (MG) and transition group (TG), formed by pregnant mares and, after delivery, infants. Blood samples were collected at the following times: T-60 (60 d pre-delivery), T-30 (30 d pre-delivery), T-15 (15 d pre-delivery), T0 (first 6h post-delivery), T15 (15 d post-delivery), T30 (30 d post-delivery), and T60 (60 d post-delivery). The TG had lower values (P< 0.05) of red blood cells, hematocrit and hemoglobin at T0, T15, T30 and T60 times than MG. The mean corpuscular volume was lower in MG (P< 0.05) than in TG (T0, T15, T30 and T60) and mean corpuscular hemoglobin concentration was higher (P< 0.05) in MG than in TG (T15, T30 and T60). On the other hand, the diameter distribution of red blood cells presented a lower value (P< 0.05) in MG than in TG (T15 and T30). Mares in transition period presented regenerative anemia. The results demonstrate physiological metabolic variations of different intensities during pregnancy, delivery and early lactation.
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Affiliation(s)
| | | | | | | | | | - P.A.N. Ermita
- Universidade Federal do Sul e Sudeste do Pará, Brazil
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40
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Fadiloglu E, Bulut Yuksel ND, Unal C, Ocal S, Akinci SB, Topeli A, Beksac MS. Characteristics of obstetric admissions to intensive care unit: APACHE II, SOFA and the Glasgow Coma Scale. J Perinat Med 2019; 47:947-957. [PMID: 31603858 DOI: 10.1515/jpm-2019-0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/07/2019] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the characteristics of obstetric admissions to an intensive care unit (ICU) and assess the utility of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and the Glasgow Coma Scale (GCS). Methods This study is consisted of 160 patients admitted to an ICU during the antenatal period or within 7 days at the postpartum period. Clinical characteristics and ICU scores were evaluated. Results The rate of admission to the ICU was 7.8/1000 deliveries. Four cases ended with maternal mortality (2.5%). The most common hospitalization indications were hypertensive disorders of pregnancy, cardiovascular disorders and obstetric hemorrhage, at 40 (25%), 34 (21.2%), and 31 (19.3%) cases, respectively. The receiver operating characteristics (ROC) curve analysis for prediction of maternal mortality revealed area under curve (AUC) values as 0.971 both for APACHE II and predicted mortality rate (PMR), and 24.5 and 47.1 were determined as the cut-offs with sensitivities of 100%. AUCs were also 0.901 and 0.929 for the initial and worst SOFA score, respectively. The cut-off value for the initial and worst SOFA score was 3.5, with a sensitivity of 100%, and was 10 with a specificity of 98.9%, respectively. Conclusion APACHE II and PMR overpredict maternal mortality, but those higher scores predict maternal mortality. Higher SOFA scores are related with maternal mortalities with high specificity.
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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Sıhhiye, Ankara, Turkey, Tel.: +90 5464750175
| | - Nihal Deniz Bulut Yuksel
- Division of Critical Care, Department of Anaesthesiology and Reanimation, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Sıhhiye, Ankara, Turkey
| | - Serpil Ocal
- Division of Critical Care, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Seda Banu Akinci
- Division of Critical Care, Department of Anaesthesiology and Reanimation, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Arzu Topeli
- Division of Critical Care, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - M Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Sıhhiye, Ankara, Turkey
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41
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Kızıltunç PB, Varlı B, Büyüktepe TÇ, Atilla H. Ocular vascular changes during pregnancy: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol 2019; 258:395-401. [PMID: 31754828 DOI: 10.1007/s00417-019-04541-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pregnancy is a period presenting with many physiological adaptation mechanisms. One of the structures in which these mechanisms are observed is ocular tissues. The cornea, lacrimal and meibomian glands, and chorioretinal complex are all among the structures affected by changes during pregnancy. In this study we aimed to evaluate the macular and optic disc vessel density (VD) changes by Optical Coherence Tomography Angiography (OCTA) imaging in pregnancy. METHODS A total of 248 eyes from 124 pregnant women and 80 eyes from 40 healthy control women were involved. Vessel densities of macula were evaluated for superficial capillary plexus (SCP) and deep capillary plexus (DCP) in whole macula, foveal, parafoveal and perifoveal region. Peripapillary and whole optic disc VDs were also evaluated. Vessel densities of macula and optic disc were compared between control individuals and pregnant women. Vessel densities in different trimesters were also evaluated. RESULTS Modest but significant differences in VDs of whole macula of SCP and DCP were observed in pregnancy group. Additionally, perifoveal and parafoveal region of SCP, whole disc and radial peripapillary capillary VD were significantly higher in pregnancy group. There was no correlation between VD ratios of macula and optic disc and pregnancy weeks and trimesters. CONCLUSIONS This is the first study focusing on the OCTA parameters in pregnant individuals. These findings suggest that physiological changes during pregnancy are not limited to the cornea, eyelids and the choroid but also to the retinal and optic disc vasculature.
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Affiliation(s)
- Pınar Bingöl Kızıltunç
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Bank, Mamak, Ankara, Turkey.
| | - Bulut Varlı
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Tuna Çelik Büyüktepe
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Bank, Mamak, Ankara, Turkey
| | - Huban Atilla
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Bank, Mamak, Ankara, Turkey
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Vonck S, Lanssens D, Staelens AS, Tomsin K, Oben J, Bruckers L, Gyselaers W. Obesity in pregnancy causes a volume overload in third trimester. Eur J Clin Invest 2019; 49:e13173. [PMID: 31545513 DOI: 10.1111/eci.13173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 07/06/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity is a major risk factor for cardiovascular diseases. In this study, we aimed to investigate the maternal circulatory differences during pregnancy between obese and normal weight women. MATERIALS AND METHODS The functioning of the maternal circulation (arteries, veins, heart and body fluid) was assessed by ECG-Doppler ultrasound, impedance cardiography (ICG) and bio-impedance during pregnancy in obese women (BMI ≥30 kg/m2 ) and normal weight, nonobese women (BMI 20-25 kg/m2 ). In this observational study, 232 assessments were performed in the obese group, whereas 919 assessments were performed in the nonobese group. RESULTS Relative to nonobese women, the overall cardiovascular function in obese women during first and second trimester is consistent with a high volume/low-resistance circulation. In third trimester, cardiac output of obese women decreases from 9.2 (8.2-10.7) L/min to 8.5 (7.6-9.6) L/min (P = .037) whereas this is not true in the nonobese women (from 7.8 (7-8.5) L/min to 7.8 (6.8-8.9) L/min, P = .536). Simultaneously, the persistently lower peripheral vascular resistance in obese vs nonobese women disappears (880 (761-1060) dyn.sec/cm5 vs 928 (780-1067). CONCLUSIONS The circulatory gestational adaptations between nonobese and obese women were generally similar. The findings in the third trimester suggest that a pregnancy in obese women start as a state of high volume/low resistance, gradually shifting to a volume overload with decrease of cardiac output and disappearance of low vascular resistance. This evolution makes obese women vulnerable for gestational hypertensive diseases.
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Affiliation(s)
- Sharona Vonck
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium.,Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dorien Lanssens
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium.,Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Kathleen Tomsin
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jolien Oben
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Liesbeth Bruckers
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Wilfried Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium.,Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department Physiology, Hasselt University, Diepenbeek, Belgium
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43
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Assessing and managing hypovolemic shock in puerperal women. Best Pract Res Clin Obstet Gynaecol 2019; 61:89-105. [DOI: 10.1016/j.bpobgyn.2019.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022]
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Alim S, Ozsoy AZ. To Evaluate Choroidal and Retinal Thicknesses in Singleton versus Twin Pregnancies using Optical Coherence Tomography. Middle East Afr J Ophthalmol 2019; 26:153-157. [PMID: 31619903 PMCID: PMC6788317 DOI: 10.4103/meajo.meajo_171_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/24/2019] [Accepted: 09/12/2019] [Indexed: 12/03/2022] Open
Abstract
PURPOSE: The purpose of the study was to evaluate the choroidal and retinal thicknesses in singleton versus twin pregnancies. MATERIALS AND METHODS: This study included 20 single and 20 twin pregnant women in their 3rd trimester with 20 age-matched healthy nonpregnant women as a control group. All participants underwent a detailed ocular examination. Cirrus enhanced depth imaging-optical coherence tomography was used for choroidal thickness (CT) with frame enhancement software. The study was divided into three groups: Group 1 – singleton pregnancy, Group 2 – twin pregnancy, and Group 3 – healthy nonpregnant controls. CT was measured from nasal, subfoveal, and temporal fields. RESULTS: Regarding CT, the twin pregnancy group had the thickest choroid followed by the singleton pregnancy group and control group. There was a statistically significant difference between Group 2 and Group 3 in terms of nasal, subfoveal, and temporal CTs (P = 0.002, P = 0.001, and P = 0.003, respectively). There was a statistically significant difference between Group 1 and Group 3 regarding just subfoveal CT (P = 0.028). Regarding retinal thickness, there was a statistically significant difference between Group 1 and Group 3 regarding the mean macular volume and ganglion cell-inner plexiform layer thicknesses (P < 0.05). Furthermore, regarding mean retinal nerve fiber layer thickness, there was a statistically significant difference between Group 1 and Group 2 and between Group 2 and Group 3 (P = 0.004, P = 0.003, respectively). CONCLUSION: Our study is the first one which evaluates choroidal and retinal thicknesses in twin pregnancies. We found that there was an increase in CT in the 3rd trimester of pregnancies and it was prominent in twin pregnancies.
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Affiliation(s)
- Sait Alim
- Department of Ophthalmology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Asker Zeki Ozsoy
- Department of Gynecology and Obstetrics, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
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45
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Kwatra D, Kumar S, Singh GB, Biswas R, Upadhyay P. Can Pregnancy Lead to Changes in Hearing Threshold? EAR, NOSE & THROAT JOURNAL 2019; 100:277S-280S. [PMID: 31565981 DOI: 10.1177/0145561319871240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study explores the changes in hearing thresholds in pregnancy. MATERIALS AND METHODS A prospective hospital-based observational study was performed with a total of 69 patients in the age-group of 18 to 40 years. Patients underwent hearing assessment twice during the study period. Conventional pure tone audiometry and impedance audiometry were performed, first during the antepartum period (28-32 weeks of gestational age) and second time during the postpartum period (6 weeks postpartum). RESULTS Significant difference was seen between the average of air conduction threshold values at speech frequencies when antepartum values were compared with postpartum values. CONCLUSION The alterations in hearing sensitivity in pregnant females which improved during the postpartum period can be attributed to pregnancy.
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Affiliation(s)
- Devanshu Kwatra
- Department of Otorhinolaryngology and Head and Neck Surgery, 28856Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Sunil Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, 28856Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Gautam Bir Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, 28856Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Ratna Biswas
- Department of Obstetrics and Gynaecology, 288561Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Prabhakar Upadhyay
- Department of Otorhinolaryngology and Head and Neck Surgery, 28856Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
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Vinturache A, Popoola J, Watt-Coote I. The Changing Landscape of Acute Kidney Injury in Pregnancy from an Obstetrics Perspective. J Clin Med 2019; 8:jcm8091396. [PMID: 31500091 PMCID: PMC6780924 DOI: 10.3390/jcm8091396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 12/14/2022] Open
Abstract
Pregnancy-related acute kidney injury (PR-AKI) is a heterogeneous disorder with multiple aetiologies that can occur at any time throughout pregnancy and the post-partum period. PR-AKI is an important obstetric complication that is associated with significant maternal and foetal morbidity and mortality. Although there has been an overall decline in the incidence of PR-AKI worldwide, a recent shift in the occurrence of this disease has been reported. Following improvements in obstetric care, PR-AKI incidence has been reduced in developing countries, whereas an increase in PR-AKI incidence has been reported in developed countries. Awareness of the physiological adaptations of the renal system is essential for the diagnosis and management of kidney impairment in pregnancy. In this review we scrutinize the factors that have contributed to the changing epidemiology of PR-AKI and discuss challenges in the diagnosis and management of acute kidney injury (AKI) in pregnancy from an obstetrics perspective. Thereafter we provide brief discussions on the diagnostic approach of certain PR-AKI aetiologies and summarize key therapeutic measures.
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Affiliation(s)
- Angela Vinturache
- Department of Obstetrics & Gynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK.
| | - Joyce Popoola
- Department of Obstetrics & Gynaecology, St. George's University Hospital NHS Foundation Trust, London SW17 0QT, UK
- Department of Nephrology and Transplantation, St. George's University Hospital NHS Foundation Trust, London SW17 0QT, UK
| | - Ingrid Watt-Coote
- Department of Obstetrics & Gynaecology, St. George's University Hospital NHS Foundation Trust, London SW17 0QT, UK
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47
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Xie S, Wu X. Clinical management and progress in sudden sensorineural hearing loss during pregnancy. J Int Med Res 2019; 48:300060519870718. [PMID: 31452412 PMCID: PMC7593668 DOI: 10.1177/0300060519870718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is a relatively rare, but distressing, disease in pregnant women. Little is known about the causes, clinical manifestations, treatments, and prognosis of SSNHL. Some hypotheses have been proposed to explain the pathophysiological mechanism of SSNHL, but most of them have not been identified. This article reviews the existing literature to present a summary of this clinical problem. Most patients suffer from SSNHL in the second or third trimester, and show moderate to profound hearing loss. The interval between the initial treatment and onset of hearing loss is less than 10 days in most patients. Some patients with SSNHL show tinnitus, vertigo, or dizziness, and fullness of the ear. Although some patients have a tendency for self-cure, treatment with intravenous dextran 40 combined with intratympanic corticosteroids is probably a safe and effective therapeutic strategy for pregnant patients with SSNHL. Further clinical research is necessary to identify the best therapeutic strategy for these patients.
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Affiliation(s)
- Shaobing Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, PR China.,Key Laboratory of Otolaryngology Major Diseases Research of Hunan Province, Changsha, Hunan, PR China
| | - Xuewen Wu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, PR China.,Key Laboratory of Otolaryngology Major Diseases Research of Hunan Province, Changsha, Hunan, PR China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, PR China
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48
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Mujica-Coopman MF, Farias DR, Franco-Sena AB, Vaz JS, Kac G, Lamers Y. Maternal Plasma Pyridoxal 5'-Phosphate Concentration Is Inversely Associated with Plasma Cystathionine Concentration across All Trimesters in Healthy Pregnant Women. J Nutr 2019; 149:1354-1362. [PMID: 31098628 DOI: 10.1093/jn/nxz082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/05/2019] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Vitamin B-6 (B-6), in the form of pyridoxal 5'phosphate (PLP), is critical for one-carbon metabolism reactions and cellular function. Plasma PLP concentration decreases throughout pregnancy, but the functional consequences of this have not been studied. Plasma cystathionine is a sensitive indicator of suboptimal B-6 status in healthy adults. OBJECTIVES The aim of this study was to determine the relation between plasma PLP and cystathionine concentrations, and to assess longitudinal changes in plasma concentrations of metabolites of one-carbon metabolism, including total homocysteine (tHcy), cysteine, methionine, glycine, serine, and glutathione, over the course of pregnancy. DESIGN This was a prospective cohort study of 186 healthy Brazilian pregnant women (20-40 y). Plasma PLP and metabolite concentrations were quantified in fasting maternal blood samples collected between 5-13, 20-26, and 30-36 weeks of gestation. Linear mixed regression models were used to determine the association of 1) first-trimester PLP tertiles, and 2) the variation of PLP concentration throughout pregnancy, with related metabolite concentrations across weeks of gestation. RESULTS Median (IQR) PLP concentration decreased from 36.2 (29.2-44.5) to 21.0 (15.9-26.0) to 16.8 (12.9-21.4) nmol/L in the first, second, and third trimester, respectively, whereas cystathionine concentration increased from 63.2 (49.7-78.9) to 122 (98.0-167) to 143 (114-193) nmol/L, respectively (both P < 0.001). The variation of PLP throughout pregnancy was inversely associated with cystathionine concentration across weeks of gestation, after adjusting for confounding factors; β (95% CI) = -0.387 (-0.752, -0.219), P = 0.04. This association significantly differed by trimester and was strongest in the third trimester. Plasma concentrations of glycine, serine, methionine, cysteine, and tHcy decreased, and that of glutathione increased, between the first and second trimesters (all P < 0.05). CONCLUSIONS The variation of PLP concentration predicted cystathionine concentration throughout pregnancy. Increases in plasma cystathionine across trimesters may reflect maternal intracellular B-6 deficiency.
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Affiliation(s)
- Maria F Mujica-Coopman
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Dayana R Farias
- Nutrition Institute, Federal University Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana B Franco-Sena
- Nutrition Institute, Federal University Rio de Janeiro, Rio de Janeiro, Brazil.,Emília de Jesus Ferreiro Nutrition School, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Juliana S Vaz
- Nutrition Institute, Federal University Rio de Janeiro, Rio de Janeiro, Brazil.,Faculty of Nutrition, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Gilberto Kac
- Nutrition Institute, Federal University Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yvonne Lamers
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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49
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Ciloglu E, Okcu NT, Dogan NÇ. Optical coherence tomography angiography findings in preeclampsia. Eye (Lond) 2019; 33:1946-1951. [PMID: 31316159 DOI: 10.1038/s41433-019-0531-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/03/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate vascular density analysis in the superficial (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ), peripapillary vascular density analysis (PPCVD), and peripapillary retinal nerve fiber thickness analysis (PPRNFL) using optical coherence tomography angiography (OCTA) in pregnant women with preeclampsia and to compare the obtained values with healthy pregnant and nonpregnant healthy individuals. METHODS A total of 98 pregnant women (55 had preeclampsia, 43 were healthy pregnant women) and 38 healthy nonpregnant women of reproductive age were included in the study. The patients were divided into three groups. Group 1 consisted of pregnant women with preeclampsia, group 2 comprised healthy pregnant women without preeclampsia, and group 3 consisted of healthy women who were not pregnant. All participants underwent a comprehensive ophthalmologic examination including OCTA. RESULTS Superficial foveal density (SFD) and deep foveal density (DFD) were lower in group 1 than in group 3 (p = 0.033, p = 0.041, respectively). Deep parafoveal density (DPD), deep temporal density (DTD), and deep superior density (DSD) values were lower in group 1 than in group 2 and group 3 (p = 0.001). PPRNFL superior and mean values were higher in group 1 and group 2 than in group 3 (p = 0.022, p = 0.029, respectively). The mean superior and inferior RPCVD values were significantly higher in group 1 than in group 2 and group 3 (p = 0.001, p = 0.043, and p = 0.001, respectively). CONCLUSIONS In preeclampsia, OCTA shows changes in the microvascular structure of the retina, even without retinopathy findings on biomicroscopy examination.
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Affiliation(s)
- Emine Ciloglu
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey.
| | - Nefise Tanrıdan Okcu
- Department of Obstetrics and Gynaecology, Adana City Training and Research Hospital, Adana, Turkey
| | - Neşe Çetin Dogan
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
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50
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Lee SY, Lee SW, Kong IG, Oh DJ, Choi HG. Pregnancy Does Not Increase the Risk of Sudden Sensorineural Hearing Loss: A National Cohort Study. Laryngoscope 2019; 130:E237-E242. [PMID: 31268583 DOI: 10.1002/lary.28170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/29/2019] [Accepted: 06/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Pregnancy-induced systemic physiological changes appear to be associated with reversible hearing changes in pregnant/postpartum women. However, most studies are case reports due to the rare occurrence of sudden sensorineural hearing loss (SSNHL) during pregnancy. We aimed to evaluate the risk of SSNHL during the pregnancy and postpartum periods. STUDY DESIGN A longitudinal case-control study using a nationwide population cohort. METHODS Using the Korean National Health Insurance Review and Assessment Service, we collected data from 63,331 pregnant/postpartum participants who were matched 1:2 by age, income, region of residence, and medical history with 126,662 control participants. We included participants who had International Classification of Diseases, 10th Revision (ICD-10) codes indicating delivery (O80-O84). For SSNHL (ICD-10 code H91.2), we included only those participants who underwent audiometry and were treated with steroids. The incidence of SSNHL was measured for the periods corresponding to pregnancy (conception through delivery) up to 1 year postpartum in the pregnant participants. RESULTS During the pregnancy period, the SSNHL rate was not higher (19.5 per 100,000) compared with the control group (60.7 per 100,000). The adjusted odds ratio of SSNHL during pregnancy was 0.32 (95% confidence interval: 0.16-0.65, P = .002). The SSNHL rate during the postpartum period (37.9 per 100,000) was similar to that of the control group (36.3 per 100,000). The adjusted odds ratio of SSNHL during the postpartum period was 1.04 (95% confidence interval: 0.64-1.71, P = .867). The risk of SSNHL in the patients during the pregnancy/postpartum period was not higher than that in controls, regardless of age and specific subperiod. CONCLUSIONS The pregnant and postpartum women were not at higher risk of SSNHL. LEVEL OF EVIDENCE NA Laryngoscope, 130:E237-E242, 2020.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Suk Woo Lee
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Il Gyu Kong
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, South Korea
| | - Dong Jun Oh
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea
| | - Hyo Geun Choi
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, South Korea.,Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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